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Peritoneal lavage in pediatric patients sustaining blunt abdominal trauma: a reappraisal
Insights
Diagnostic peritoneal lavage (DPL) in pediatric blunt abdominal trauma is highly sensitive. A positive DPL result in children requires further evaluation to avoid unnecessary exploratory celiotomies.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Diagnostic Procedures
Background:
- Blunt abdominal trauma is a common injury in children.
- Diagnostic peritoneal lavage (DPL) is a procedure used to detect intra-abdominal injuries.
- The oversensitivity of DPL can lead to unnecessary surgical interventions.
Purpose of the Study:
- To evaluate the utility of diagnostic peritoneal lavage in pediatric patients with blunt abdominal trauma.
- To determine the rate of unnecessary exploratory celiotomies following positive DPL results.
- To assess the need for further diagnostic evaluation after a positive DPL.
Main Methods:
- Retrospective review of 128 pediatric patients (0-18 years) who underwent DPL for blunt abdominal trauma.
- Analysis of operative findings and the necessity of surgical intervention in patients with positive DPL results.
- Comparison of DPL results with operative outcomes.
Main Results:
- Out of 128 patients, 78 had negative DPL and 50 had positive DPL.
- Forty-one patients with positive DPL underwent exploratory celiotomy.
- Twelve of these exploratory celiotomies were deemed unnecessary based on operative findings.
Conclusions:
- Diagnostic peritoneal lavage is highly sensitive but lacks specificity in pediatric blunt abdominal trauma.
- A strongly positive DPL result in children necessitates further diagnostic evaluation before proceeding to exploratory celiotomy, unless the patient's clinical condition mandates immediate surgery.
- Optimizing the use of DPL can reduce non-therapeutic laparotomies in pediatric trauma patients.
Abstract:
One hundred twenty-eight patients from 0 to 18 years of age underwent diagnostic peritoneal lavage following blunt abdominal trauma. Seventy-eight had negative lavages and 50 were positive. Forty-one patients underwent exploratory celiotomy after positive lavage results. A review of the operative findings and need for surgical intervention led to the conclusion that 12 of these operations were not necessary. Due to the oversensitivity of peritoneal lavage a strongly positive result mandates further diagnostic evaluation unless the patient's clinical status requires exploratory celiotomy.